We should all be asking questions. Is there not something wrong in a profession proud of its ethics and its caring which allows this to happen without there being a national inquiry that is acted on? We are apparently a profession that hides these statistics; a profession unwilling to deeply review the culture of medicine, which is perhaps the underlying cause of these untimely and tragic deaths.

Our young doctors are the backbone of our hospital workforce. Our community has invested highly in their education. Medicine needs them to form the reliable, compassionate and competent workforce that our patients require. They are the future of medicine. We should value and nurture them and provide all the support they deserve.

As doctors, we can no longer stand back and blame the system which is contributing to this tragedy. We need to stand up and challenge it.

Studies of physician mental health and suicide

When I look at the pictures accompanying reports of doctor suicide, I see not a statistic, but a young and beautiful man or woman in the prime of their lives. I see a young doctor who has studied hard and made sacrifices to join the profession that they dream will bring life fulfilment. I see a beloved daughter or son, sister or brother, partner and friend. I read of passion and commitment, of dedication, of selflessness. I feel a deep sadness that our profession has let them down, and a rising frustration that we have been unwilling or unable to manage the problems within our profession which have brought us to this place.

A 1996 review of published articles on doctor suicides found that the estimated relative risk varied from 1.1 to 3.4 in male doctors, and from 2.5 to 5.7 in female doctors, respectively, as compared with the general population, and from 1.5 to 3.8 in men and from 3.7 to 4.5 in women, respectively, as compared with other professionals. The crude suicide mortality rate was about the same in male and female doctors, whereas in the general population, it is four times higher in men.

The Australian beyondblue figures looking at medical student and doctor mental health found that 3.4% reported a high level of psychological distress. One in four had milder psychological distress, including depression and anxiety. Young doctors and female doctors were at highest risk. Men were at higher risk of overuse of alcohol. One in ten had suicidal thoughts in the past year. Suicide is but the tip of the iceberg for a very distressed population of young doctors.

Barriers to seeking care

Doctors’ stories of their own journey with mental health problems follow similar patterns. This is from a young doctor studying for his fellowship exams:

“I was studying for the second part of my fellowship exams and I developed an anxiety disorder. Prior to this, I had always been considered competent, now I became terrified I would not be able to intubate one of the tiny babies we cared for. It was a nightmare.

I did not go to a doctor; I did not have a GP.

I did not understand the nature of anxiety or for that matter depression; I thought I was going mad.

I felt ashamed to tell anyone in case I lost my job, my income, respect.

When I admitted my stress to my specialist he sent me to see a colleague in the other hospital I worked in, I did not tell him what was happening because I was concerned about confidentiality and being ridiculed.”

Studies show that this is what happens to doctors with mental health problems. They may self-diagnose and even self-medicate, often misdiagnose and incorrectly medicate. They find it difficult to seek help – because of time factors, confidentiality concerns and fear of losing their job – and when they do, the help is not always what they need.

Mandatory reporting

Mandatory reporting is supposed to protect the public from doctors whose competency is in question. Unfortunately, it is having the effect of discouraging doctors from seeking the care they need, which in itself could be putting their patients at risk.

“It is clear to me that provisions such as mandatory reporting are stopping doctors and students from accessing care, or are making them fearful of the consequences if they do require support.

We have to change this because it is not making our doctors or our patients safer.”

According to a recent media report, an English GP registrar who had been previously named registrar of the year had voluntarily reported to the General Medical Council about a drinking problem. Believing he was going to fail a urine test after a party, he took his life.

What can we do?

Many strategies have been shown to be successful in trials: all of them look at the support and treatment of young doctors. It is essential that we provide training and funding to incorporate these measures into our medical schools and hospitals.

We should stop hiding from the fact that as a profession we have a problem and do our best to prepare our students and doctors for the stresses they will face. We should encourage them to identify and engage with a local GP every time they move location, so this becomes automatic.

Validated online cognitive behavioural therapy and mentalisation-based treatment programs should be designed specifically for doctors and offered at no cost. They should be introduced through medical school and advanced programs should be offered as they advance in their career and the stressors change. Hospitals should offer dedicated down time where young doctors, under the supervision of senior clinicians or psychologists, can learn the value of reflection, self-awareness and connectedness.

I believe a mentoring system could be offered through Medicare, where each junior doctor is coupled with a GP trained in the management of mental health disorders and who is aware of mental health problems as they relate to doctors. For this to work, there needs to be a review of the mandatory reporting system, so that at the very least doctors are supported and cared for in a way every patient deserves.

Suicide is more common in female doctors and in recent years, gender equity means that there are now equal numbers of men and women entering medical schools. If we fail to deal with the causes behind these sad and tragic deaths, as the balance between male and female physicians changes, we are likely to see more, not fewer deaths.

We have been aware of the mental health problems in doctors for many years and we have tried many strategies, but there is no real evidence that they are working. I believe this is because we are trying to treat the doctors, but we are failing to manage the fundamental flaws in the medical system and the medical training system which underpin these problems.

Until we do this, our young doctors will suffer and some will pay the most awful of prices. This demands the complete honesty and humility of our profession. We can no longer, in our collective arrogance, believe we are invulnerable, invincible and not open to scrutiny. We cannot blame our problems on the system without being willing to engage with the system to look for viable solutions.

If we truly believe that compassionate care is fundamental to medicine, we must treat our students and junior doctors with the care we would like them to show us.

Dr Jane Barker has been practicing as a GP in northern NSW for 30 years. She is a GP academic in the University Centre for Rural Health based in Lismore and a GP in the local Aboriginal Medical Service. Her interest in global health issues comes from growing up in Zambia and later working in Papua New Guinea.

If this article has raised issues for you, help is available at Lifeline on 13 11 14, and beyondblue on 1300 224 636.

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37 thoughts on “Flaws in the system are killing young doctors”

I have problems with OCD and see a psychiatrist for this. I mention this to the medical student intake at my hospital and don’t try to hide it from my colleagues. I’ve never found any negative responses to this and on several occasions other doctors have come up to me to tell me of their similar problems.

I saw a specialist, recognizing I was ill. Due to mandatory reporting requirements, I was reported. My career is now in ruins. Fortunately I’m senior enough to see light at the end of the tunnel. If I was 20 years younger, I reckon I’d be dead by now.

We know from work across organisations that trying to reduce the prevalence of mental illness and it’s consequences at work through treatment is a flawed and ineffective approach. We need to tackle the modifiable risks for the ill health and suicides. i set up the UKs first occcupational psychiatry service for health professionals over a decade ago. We realised then that the system needs to change. Talking to our BPTs the cruelty of the system beggars belief.: A first posting to a rural base hospital with minimal professional and virtually no personal support, overwhelming demands and no control are a guarantee of high levels of mental ill health. Let’s do something useful to tackle the root cause rather than yet another band aid and a blind eye

Due to the efforts of the Colleges, there has never been less bullying and harassment in medicine.
AMA safe work hours policy means that trainees work fewer hours than their historical peers. Technology has made communication and record keeping easier. The medical curriculum has expanded as the knowledge base has grown, but increased sub-specialization has meant that there is less expectation to know everything.

Every suicide is a tragedy, but medicine is a high-wire act and has always had higher rates. Blaming ‘the culture of medicine’ is too easy – one may as well blame ‘The System’ or ‘The Man’ – especially when the features above suggest the system has never been better.

Ensure that you also look at those entering medicine, and make sure they have the resilience in the first place to be equal to the task.

I’m curious how functional the ‘professional supervision’ system is. Psychology, Social Work and other health professions have mandatory and formalised supervision which includes debrief. Supervison relationships are not necessarily directly within a work unit.

This critical issue just won’t go away! No magic! An earlier Departmental of Health review in 1996 achieved nothing, with many international evaluations mostly unsuccessful in the longer term. A very recent NEJM Perspective simply called “Kathryn” is heartbreaking. Where success arises there is usually a protagonist, eg Dr Rachel Remen at UCSD, or Dr Craig Hassed at Monash. Both acknowledge the inordinate and unavoidable stress experienced by all medical students and young doctors, often with suicidal ideation, and all too often with a completed suicide. Placing the vulnerable in “harms way” is brutally callous and inexcusable. A compassionate “protagonist” would aim to prevent, mitigate or transform the stress well BEFORE catastrophe arises. Ultimately this produces resilient, kind and insightful doctors, who communicate well and make fewer errors.
I am a medical oncologist and went through hell way back with major depression and months of suicidal ideation. The “system” failed me and I found recovery elsewhere. My offers to provide honorary (and honorable) help to medical students and young doctors, based on my experience and expertise, and based on evidence, have been rejected by two Sydney teaching hospitals, but recently a third has offered serious support for the idea. Much more needs to be done.

All the counselling and correction of the system will have no effect unless the person’s nutritional and hormonal state is assessed and corrected. Doctors are eating just as poorly as the rest of Australians and are prone to deficiencies of B vitamins, zinc, magnesium, omega 3 and protein. How is a person working those long hours able to cook and eat the Mediterranean diet that has been shown to be as effective as SSRIs in the treatment of depression? How do you get enough magnesium to prevent anxiety and insomnia unless eating mounds of greens and pulses? As well as stress management, these doctors need a nutritional doctor – look for one via ACNEM.

I am a specialist in training in Victoria. I was working at a regional hospital a couple of years ago when one of our residents took their life. When a friend told me she thought that I had depression last year, I was terribly afraid my career might be over. Some days I wondered if that might be a good thing, forcing a decision to persue another career, one that did not take such a toll on my health and my personal life. Despite “flexible training” pathways, “trainee support” programs and workplaces promoting “self care” and “wellbeing” for trainees, medicine is still a brutal career to choose. Bullying occurs in every workplace I have been in. Sexism is widespread. Many doctors appear to be suffering from “empathy fatigue”, not because they are unfeeling, but because they are overworked and under immense stress. What little empathy they can muster is directed to patients, with none left for colleagues. Self care seems to be at odds with the demands of service provision and specialist training. I doubt that the extent of harm to medical professionals by the culture that exists in medicine and in health facilities will be reflected in statistics. “Depression” may have been the medical diagnosis given to a doctor who took their life, but that makes it sound rather one-dimensional. Work stress, training requirements, difficulties in personal relationships and lack of support people would, I’m sure, be contributing factors in the majority of cases. Not only is medicine a stressful career, but many doctors I know slowly drift away from friendships outside of their medical colleagues. We are just too busy, or too tired, to attend every dinner party, morning tea, picnic and birthday party. One day most of your supports are also doctors. And the last people you want to talk to about work-related stress are the people you work with. Hence, the culture of “pushing on” and “sucking it up” is perpetuated. Citing that rates of suicide and bullying are “lower than they’ve ever been” (anonymous, above) misses many important points. This statement assumes that the “statistics” are reliable, which I doubt very much. Secondly, to quote Gloria Steinem, “gratitude never radicalised anyone”. Just because something is better than it was 2 generations ago, doesn’t mean it’s OK the way it is. Any doctor or medical student taking their own life is one too many. We work in a field where self care and self awareness are very important in maintaining quality care for others. Many of us have spent years at university, then many more years in semi-structured training. Why aren’t we doing better at this? You hit the nail on the head when you said we are failing to address “fundamental flaws in the system” and our “collective arrogance” perpetuates these problems. Self reflection is hard. Collective reflection on the culture and practices in medicine is really hard. We are forced not only to identify toxic attitudes system-wide, but also question our own, individual role in that system. Each time we participate in, or even ignore, bullying we allow it to continue. Each time we respond to a colleague who is experiencing difficulty with “that’s nothing, when I was an intern we had to …” we not only perpetuate unhelpful attitudes towards work, but miss an opportunity to support a colleague who might be really struggling. I hope that I can continue to treat my colleagues, students, and even myself, with the care that we deserve. Even if the system is slow to adopt this attitude.

I don’t think mandatory reporting is the correct way to address this issue. I think that if a doctor has demonstrated insight into their mental health problem by acknowledging and seeking help and if required taking time off, and is not deemed by their treating doctor (GP and/or psychiatrist) to be a danger to their patients, then I don’t think that they should have to be reported.

Rather than focusing on the individual – the nature of the job should be analysed – some have the intellectual capacity but not the suitability for the occupation. So the problem could be minimised if the personality be detoured to another occupation or a more suitable branch of the current occupation.
It is not specific for medicine – but other occupations may have more of elasticity in job performance whereas medicine has none. A lot of intellectually capable people cannot withstand adversity whereas street smart people may be more robust – in fact the pampered generations – those that have not been involved in societies stresses – e.g. wars , economic downturns, migrations and other dislocations etc. tend to be more fragile. This has been described over 100 years ago .
Mandatory reporting should be abolished unless spread to all occupations – including parliamentarians and the public service.

It is crucial that we focus on this issue and start to act now. We have developed a ‘ focus your mind’ module for doctors that has shown reduced impact of stress on first year doctors. We are also trialling a web based stress management and mental health self assessment and CBT tools designed for doctors. If this proves to improve doctors stress and mental health then it will be free to all doctors.

Katherine@9., your comment is obviously heart-felt, but you and others seem to imagine that it is possible to remake Medicine in some way.
There are a few big intrinsic elements that are not open to change:
*medicine is a demanding career
*there is a lot to learn
*there is enormous responsibility
*patients by definition are needy, and as autonomous as we might make them, they still need their doctor to be their rock and unfailing guide
*doctors are privy to existential insights denied to many others
These things are just Medicine.
Self-reflection is not that hard: you are not compelled to do Medicine.
(Anonymous@5)

“Due to the efforts of the Colleges, there has never been less bullying and harassment in medicine.”

Sounds like someone who works for a college. Typical and completely disconnected from reality. Bullying is still widespread but isn’t the classic in your face style of yesterday. It takes different forms. The colleges could care less about the well being of the registrars. Their policies protect their own organisations, not the training doctors. The biggest issue is that senior doctors simply do not teach in a huge percentage of hospitals. This is one form of bullying. No teaching is more harmful than putting someone down at work. It adds massive stress since the registrar has to study even more hours after work.

College exams are difficult to the point of being ridiculous. They get income from the exams. Recently, the rural GP exam saw a failure rate of over 50%. Were there over 50% that are bad doctors. Highly unlikely. A big part of the issue is the toxic culture that the colleges bring. They should not be laws upon themselves and hopefully one day this will change.

It’s simple
at least 5 years of undergraduate study, usually 7 to 8
your whole adult life spent studying, with ongoing postgraduate study requirements just as high as undergraduate demands (when you were a full time student)
too much work and not enough time or money to do it properly
critically high levels of responsibility (people die if you stuff up)
Ongoing high levels of exam stress, with the constant threat of increasing ongoing CME requirements
too many personality impaired nutjobs in senior hospital teaching positions (I wonder how many doctors reading this can honestly say they never met a senior specialist with personality problems during their training) and the bad apples tend to colour your training more than the many genuinely good teachers
not enough money to make your career viable if you do try to cut your hours
Are the suicides really a surprise? Maybe we should be surprised there aren’t more of them.
. . . 🙁
the smart ones go off to work for macquarie bank. Or become some sort of lawyer. My kids are all going off to do something other than medicine, and best of luck to them. By the time I’m old enough to need a good GP – THERE WILL BE NONE. Medicare and the health department will have destroyed them all.

Thank you, anonymous @14 for your comment. I should clarify though, I (and others) are talking about changing the human culture around medicine, not changing medicine itself. Yes, it is a demanding job. Yes, patients are needy, and I have worked with some of the neediest. They are why I do my job. Or rather, vocation, as that is how I (and many others) see this line of work. We do have many insights others do not have. And whilst no one is compelled to do this work (yes, we are exercising free will) for some (many?) there is a sense of responsibility to use our skills and education to help fellow humans. I do not want to change any of these things. They are the reason I go to work and (most days) love what I do. What does need to change, and can, I believe, change, is the bullying, the discrimination and otherwise toxic culture that exists in hospitals, colleges and other healthcare facilities. These attitudes do not serve our profession and do not serve our patients. What it does is eat doctors alive. Promoting individual resilience is not enough. This does not make us impervious to difficulty, only help resist it and recover from it. The first step to changing the culture in medicine is believing that it can change.

@anonyomous 5. Do you have any evidence for any of your preamble? As a junior living the system I would respectfully disagree with almost everything that you said.

Overall I found this a good article that sheds further light on an issue that needs to be dragged from the shadows.

However, I find it interesting that of all the recent literature on physician suicide, I am yet to find a single article that references the training crisis. I believe that the failure of so many senior doctors to recognise its influence on juniors’ wellbeing is a huge part of the problem.

Apply to become a surgeon and you have about a 20% chance of getting onto a program, apply to become a GP and you might be 1 of around 800 people to miss out. Look for a structured pathway to these programs and you will find it sorely lacking. Spend too long trying to get onto a program and you become too expensive to employ – career over.

In that cut throat environment with next to no career predictability or security it’s no wonder anxiety and depression thrives.

my view on this is simple – it is tragic when a life ends too soon at one’s own or other’s hand. this should not be seen in our own group as we are a “caring profession”.
sadly, this is not so, as we and others put very high expectations on ourselves and on each individual. this is mainly driven by the job we do, make a mistake and your patient / relatives suffer, and you may suffer in turn the legal / career consequences.
but this is exactly why the training is so rigorous, to instill high levels of knowledge and experience, so mistakes are not made easily and we learn how to cope with making them. personally, I would live through my supervisors as a registrar telling me off rather than a coroner/judge.
medicine is not changing if anything, we are expected to do more, and yet, the young doctors go into specialties seeing only the benefits and the glory of the job. they do not seem to be able to see that if a specialty training is not for them, they should rethink, and change to something that suits their personality or family situation better. resilience is a thing that is rare – we all have to cope with tough times, personal and professional disappointments. it is how we overcome those that shows our resilience. we need mentors, but we also need Colleges to make it easier to show trainees when they are not performing, rather than making ti so difficult everybody just gives them a pass.
lastly, it is the families of those young doctors I feel for – they do not deserve to lose their children, brothers/sisters. how to make things better. pick them up early, offer help, and hope. but the AHPRA needs to get out of compulsory notification for those that actually seek help. this way, we will all have GPs, and if need be psychologists/psychiatrists to see. we should take AHPRA to task in those coronial inquests, as to why they make it impossible for us to feel like another person / patient. alternatively, suggest frequent flights to New Zealand and private care there to escape scrutiny. this is my advice to those who do not wish to be reported for seeking and getting better. Drastic situation deserve a solution.

@18 Training Crisis: the peak intake of medical students occurred in 2010. It has tailed off since then, and in the next 5 years or so, therefore, the pressure on training posts will ease somewhat as these cohorts pass through.
That’s not medicine’s fault; that’s not the Colleges’ fault: best blame the Guv’mint for a short-sighted political fix.

It starts in medical school. When I disclosed – in my first year – that I had bipolar disorder, I was referred to the School’s Professional Behaviour and Registration Committee, which is empowered to act with the delegated authority of AHPRA. The Committee wanted mandatory quarterly reporting on my mental state.

The experience drove home that would be no place in medicine for me after I graduate. In a way, I’m lucky to have been exposed to this right at the start, before I could get too invested in my career. Fortunately, there are lots of other things that you can do with a medical degree and a mental illness – just not, it seems, the clinical practice that drew me in in the first place.

@20 respectfully you are wrong. 3828 students were admitted into medical schools in 2016 across Aus and NZ, versus 3468 in 2010. There is some variation year on year but the overall trend since 2010 has been an increase in both domestic and foreign students.

Furthermore, at no point in my comment did I lay blame or assign fault. Squabbling over such matters is pointless.

The reality is that hundreds, if not thousands, of juniors are trapped in career limbo and it is my personal opinion that this is very poorly understood, and therefore poorly supported, by supervisors, consultants and hospitals. I hypothesise that this exacerbates better understood phenomena such as bullying and harassment, leading to worse mental health outcomes for doctors in training.

I do not mean to imply that a lack of understanding is through malicious intent.

@19’s comments provide a classic example of how the current training crisis is misunderstood: “they should rethink, and change to something that suits their personality or family situation better”

@19’s comments are supportive and, from my reading, well intentioned. But doctors cannot simply change specialities these days. Say you spend the first 4 years of your career trying to become an Orthopaedic surgeon before deciding to change. The earliest you can apply for the Ortho program is the start of 4th year. By this stage you will have sat, and passed, a $4000 exam (a prerequisite to apply for training) and likely done further speciality specific postgraduate training at your own expense. Imagine that application is unsuccessful and you decide to change track to GP training. You are unlikely to have any of the prerequisite rotations to be eligible for GP training. After all, you’ve spent 4 years battling to become a surgical trainee. So your first challenge is finding a hospital that will employ you for a PGY2 job at year 5 rates (as there is an arbitrary pay increase with no real right to individual negotiation). If you get past that step, which I would argue is nearly impossible considering the saturation of graduates, then you will soon have to sit another GP exam. All to improve your odds from 30% to around 66% whilst becoming more and more expensive for hospitals to employ and therefore less likely to find a job.

Now I admit there are some technicalities to these points, but really, even switching is becoming a nightmare for juniors. There is much more that could be said on this topic but hopefully this has helped to highlight one of the many issues.

I am a medical student and am a few weeks away from my final exams. At the end of my second year of graduate medicine I was diagnosed with depression. Lucky for me I have a very supportive family and I noticed I wasn’t right and I took six months off to get my self better. I freely told my medical school and they suggested that I self report saying there is nothing wrong with it. I self reported and was in a anxious mess for the next few weeks as I was expected to see a new psychiatrist, get a report from my GP and current psychiatrist. After all this I had to sit in front of a panel and talk about what happened and how I feel. They were lovely but they told me that if they rule that my depression causes me to have an impairment I would be only have to get restricted registration as a doctor!!
At no time was I told this before. My medical school never told me this! I was panicked. Felt like my life as a doctor was over before it had even started. I stayed in this frame of mind for two weeks before the final report was handed down saying that I was fine and was not put on the register!
All this happened as I was on full time placement and looking back still not my normal self. This could have made my depression control me again but it didn’t!
If I was told before hand that me telling he medical board that I have depression would limit what I can do I would have never disclosed my condition!
I am back to my normal self but there is a cloud still over my head. Being placed in a rural community I still travel 400km to see my old gp because I don’t want anyone in my current town know I take antidepressants.
We council patients that depression is nothing to be ashamed off but we as medical students and doctors hide our mental health issues from the world.
We need to change this!

I regret to say that not all of my colleagues are nice, well balanced people. There is a saying in the USA that “sh1t floats”, and that is just as true for medicine as for any other profession. Of course there are many in positions of power who remain compassionate people, but competition and ambition are powerful and negative selection criteria. There have been a few little beacons of compassion where some junior doctor colleagues have bucked the system and been mutually supportive during my “training”. Support from senior colleagues during my training was not only non-existent, but positively hostile to any discussion of how negative experiences could be improved upon.

I too was subjected to bullying, destructive criticism and prejudice. For five years I was too scared to take anti-depressants for fear that it might become known that I was inadequate. The compassion of my GP was wonderful, but after the 10 mins of the consult, I had to return to the living hell that was junior doctor training.

Now I am a GP, part-time, taking anti-depressants and well practised at compartmentalising so that I do not let the system get to me (so much), and taking plenty of time for the things that I really enjoy (hint, not medicine).

N=1 x several anecdotes.
Obviously a selection bias here in those who feel the need to vent.
I am sorry for those who have had negative experiences, but I cannot relate them from my own medical training, which was just demanding, as expected.

Is anybody working on a better alternate solution to this problem or is everybody still in the “it isn’t fair!” stage? Obviously there is a problem with mental illness, the culture of medicine to the existence of mental illness and mandatory reporting. I am yet to read anything about proposed solutions. Are there any articles on that?

It is an industrial problem – The universities industrial system is as many bums on seats as can fit for the maximum return. As a result a high fee course such as medicine attracted unsuitable candidates but with a suitable scholastic achievement. As a result there has been an oversupply of medical, dental and other healthcare workers for of the Australian Society. It all started with the law now the law is saturated the healthcare sector will be saturated going on to the computer and robotics and the next trend. Universities have not served Australian society very well they are just a Centrelink diversion for the intelligent unemployed. Our society does not have this problem in the trades.
This is the reason why suicide and mental health problems arise in the people who go into a demanding workplace with starry eyed expectations divorced from the real world of commerce. So suicide is a social Darwinian process – very tragic for the close social group such as family, friends and colleagues but of no consequence for the general society other than removing a fragile component of that portion of the social system
It is notable in one of the comments that website has been established-websites don’t provide any treatment or help and has been no study that they have any effect. It is a copout of government and society that each problem will be solved with a website rather than any substantial human endeavour.

I’ll be finishing up medical school this year and I can honestly say that one of the biggest thing that has led to anxiety and depression in our cohort has been being forced to go rural. Last year I was required to go rural – as soon as I found out I wanted to drop out. Growing up in a rural area I didn’t have anything against this, but medicine is really hard and having a strong support network is paramount to getting through. When I was forced to go rural it took away my friends and family and I didn’t know anyone at all. I don’t like making friends with doctors and medical students because I like to not talk about work outside of work, which meant I was completely isolated from everyone in what turned out to be the hardest year of my life. If it has done anything it’s teach me that I don’t want this for myself because I was way too close to losing it, if I hadn’t made the call to get out of medicine I would have killed myself. Now I’m excited to finish this year and move into a different career – it’s not worth it.

Much of this looks at what can be done when the trainee doctor is starting to feel the strain or is getting frankly depressed. Is anything done in the interval between graduation and starting the first job? It seems to me that this is the time that something could be done to prepare the newly graduated for the problems ahead.
I was fortunate to train at a hospital in the UK (KCH) where bullying did not seem to occur – at least in the teams I trained in -and we were seen as future colleagues. I think that a lot of bullying is part of a tradition among senior doctors – “this is how I was trained etc etc” and somehow this needs to change. Perhaps if senior doctors were to realise that solicitous training of juniors would produce much better results in the wards, this would help.

When I started first year medicine in the 1970’s there were 126 fresh faced undergraduates ; when I graduated 6 years later there were only 73 of the original cohort. Charles Darwin put it well ” It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change”. Medicine is a most demanding discipline and all of us have had to adapt, but many did not. The key question is does our training process facilitate adaptation or is it a more brutal “survival of the fittest”. The key drivers of suicide are feelings of “defeat and entrapment” – the remarks in this thread indicate that some of our junior colleague experience these feelings. Suicide ( having spoken to a number of patients who have attempted it) is often not the result of depression , but very much a sense of being completely defeated by illness or personal circumstance. They are confronted by a problem for which they can see no other option but suicide. The patients I have dealt with see suicide as a rational choice to a situation that has completely defeated them. So any effort to address this issue must identify the problems that cause an overwhelming sense of “defeat” and provide solutions to address these problems. Without the availability or ability to identify alternative solutions, some young doctors will continue to see suicide as the only ” way out “.

Dear WakeUpAndSmellTheRoses ,
barring Government attempts at stopping me from practicing (eg revalidation ) I will still be a GP in 2033. There might be a functioning NBN by then, and virtual reality controlled robots to deliver care, so I might be able to be your GP, at a distance. Better yet, I may have facilitated the training of a GP who lives near you, who could do the job more efficiently. As far as I can tell, our training programmes do not involve bullying. With AMC accreditation pending the “i”‘s have to be dotted and the “t”‘s crossed. Trainee representation and community representation is mandatory. Yearly review of teachers, facilitators and mentors is mandatory. Per face to face meeting review is mandatory. Yes, I have seen bullying, and a luckily non-successful suicide attempt from one of my friends at medical school. I was probably bullied as an intern, but was too overworked, and naive to notice, was bullied as a JHO, but was desperate for a job, so stuck with it, was bullied as an SHO, but by then was getting used to it, and then got bullied as a PHO, so when the yearly contract finished I did not reapply for a position. did locums for mates around the State, went back to help one of them as an Assistant the next year, and am still there 29 years later. Wouldn’t change a thing. What hasn’t killed me has made me stronger, however, I reserve the right to influence my College’s training programme to prevent bullying.

Reality is that all positions of power attract people with personality disorders, and those with callous disregard for others and lack of empathy have the greatest chances of succeeding in the competition for positions of power and influence. Of course some people with ethics and integrity may succeed too, but they usually represent a minority. We find that in politics, in the courts, but also in medical boards and colleges or any other position with power.

Instead of policies informed by careful weighing of available evidence and reflection on possible outcomes, ideologists and fanatics of all colours generally have their way.

Mandatory reporting is a prime example of this – available evidence suggests it generally causes more harm than good, and yet it gets implemented and defended no matter how horrible the outcome.

We GPs who have “made it through” can be the Mentors we wish we once had.
It’s easy….. just be nice to your medical students and registrars. Treat them like your own sons and daughters.
Ask them about themselves, their worries, their joys, their dreams. Be human.
Anyone can teach them Medicine. Let’s show them Humanity. It might just save a life.

Humanity – now that’s one thing that unites us in our common-ness. No matter what the experience, one can always muster compassion for others if it is there for oneself. To understand that we are not what we do, we need not give our strength and power away to the system around us, to those who may criticise, speak harshly, rudely or be outright unkind, is to know with humility that one can simply be and offer all the natural strengths that are uniquely you, those personal qualities that make you spark the way you do, into the service of medicine.

Such a great article Jane. I agree, we need to address our systems. Our systems at the moment are based on function learning knowledge facts figures and information but despite the fact that we work in a health ‘care’ system our systems are without care for people at present. Care is a fundamental part of the humanity of us all, and if we remove care then we remove a person’s humanity. Removing care from the health care system makes it about facts and figures and protocols and not people. As people we all thrive when we are cared for. If we are seeking doctors who are thriving, we need to care for them, and ourselves, and then in that, we will have a more caring health care service.